Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries

Depression in pregnancy increases the risk of behavioural and emotional problems in children, says a new review focussed on low- and middle-income countries and published in The Lancet Psychiatry.

The authors of the review, led by Professor Vivette Glover at Imperial College London, call for urgent interventions for mothers and children.

Previous work from a team at Imperial College London suggests depression during pregnancy may affect the development of the baby while in the womb, as well as affecting bonding between mother and child after birth.

The review has shown that depression or anxiety can reduce the enzyme in the placenta that breaks down the ‘stress hormone’ cortisol, possibly causing more foetal exposure to the hormone. The foetus may also undergo epigenetic changes under stress, where underlying DNA stays the same but expression of that DNA is altered, perhaps affecting mental health during childhood.

However, there is a substantial lack of research specific to women in poorer countries, where interventions such as cognitive behavioural therapy may not be available. Until now, much of the research into depression during pregnancy has focused on high income countries. The team argue that the problem is more common in low- and middle-income countries, and hence more resources are now needed in these areas to help expectant and new mothers.

Not only is more investment needed in research, but also the development of appropriate low cost interventions that are specific to these areas.